Endometrióza postihuje přibližně 10 % žen ve fertilním věku a její hluboká infiltrující forma způsobuje závažné důsledky na plodnost, klinické potíže dle postižených orgánů (močový a trávicí trakt) a bolest, která výrazně ovlivňuje kvalitu života. Resekční výkony na postižených orgánech bývají složité a často si vyžadují multioborový přístup. Resekce v terénu těžké hluboké infiltrující endometriózy je komplikovaná obtížnou identifikací resekční linie. I když jsme schopni většinu resekčních výkonů provádět laparoskopickým přístupem, pořád jsou zatíženy významným rizikem per- a pooperačních komplikací, z nichž nejzávažnější je vznik rektovaginálních píštělí. Identifikace hranic endometriálního uzlu a zachování vitality tkání je u resekčních výkonů z tohoto pohledu kruciální. Endometriotické uzly na základě patogeneze vzniku léze mají různou vaskularitu, a tím pádem i různé perfuzní vzorce, přičemž vzhledem k charakteru tkáně a stupni vaskularizace má většina hluboko infiltrujících uzlů spíše hypoperfuzní vzor. Prostředek, který by umožňoval cílení (vedení) resekce pomocí sledování perfuze tkání, by mohl mít užitečné terapeutické využití. Takovým prostředkem by mohlo být fluorescenční barvivo indocyaninová zeleň. Cílením resekce pomocí fluorescenčního barviva bychom mohli být schopni managementu orientovaného na patogenezi onemocnění, a tím i šetrnější resekce s menší destrukcí tkání, s redukcí per- a pooperačních komplikací a zároveň zlepšení kvality života pacientek, co se týká bolestivosti, rizika recidivy a zachování fertility.

Endometriosis affects approximately 10% of women of fertile age and its deep infiltrating form causes serious consequences for fertility, clinical problems depending on which organs are affected (urinary and digestive tract) and causes serious pain which seriously impairs quality of life. Resection of the affected tissue tend to be complex and often require multidisciplinary approach. Resection in the field of severe deep infiltrating endometriosis is complicated by the difficulty of resection line identification. Although we are able to perform most of the resections laparoscopically, there is still significant risk of intra and postoperative complications, the most serious of which is the formation of rectovaginal fistulas. Identification of boundaries of the endometrial nodule and preservation of tissue vitality is crucial in resection procedures. Endometriotic nodules, based on the pathogenesis of the lesion, have various vascularity and therefore different perfusion patterns. According to nature of tissue and the degree of vascularization, most deep infiltrating nodules have rather hypoperfusion pattern. A substance that would be able to guide the resection by live monitoring of the tissue perfusion, could have useful therapeutic applications. Such substance could be the fluorescent dye indocyanine green. With resection guidance by fluorescence dye, we could be able of pathogenesis oriented management of the disease and therefore perform more gentle tissue preparation, with less collateral damage, reduction of intra and postoperative complications, and thus improvement of the quality of life of patients in terms of pain, risk of recurrence, and preservation of fertility.

INTRODUCTION: Anti-amyloid antibodies for the treatment of Alzheimer ́s disease (AD) are currently being evaluated for approval and reimbursement in Europe. An approval brings opportunities, but also challenges to health care systems across Europe. The objective of this position paper is to provide guidance from experts in the field in terms of navigating implementation. METHODS: Members of the European Alzheimer's Disease Consortium and a representative of Alzheimer Europe convened to formulate recommendations covering key areas related to the possible implementation of anti-amyloid antibodies in AD through online discussions and 2 rounds of online voting with an 80% threshold for a position to be accepted. RESULTS: In total, 24 recommendations were developed covering the research landscape and priorities within research in AD following a possible approval, potential impact on health care systems and diagnostic pathways, and communication to patients about anti-amyloid antibodies. Anti-amyloid antibodies are regarded as a substantial innovation with an important clinical impact. In addition, however, new compounds with other mechanisms of action and/or route of administration are also needed. Approval of new treatments will require changes to existing patient pathways and real-world data needs to be generated. CONCLUSION: Comprehensive guidance is provided on the potential implementation of anti-amyloid antibody therapies in Europe following possible approval. Emphasis is placed on the necessity of regularly updating recommendations as new evidence emerges in the coming years.

• MeSH
• Alzheimer Disease * drug therapy   therapy   MeSH
• Amyloid beta-Peptides * immunology   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Europe MeSH

Shrnutí současných poznatků o použití skleroterapie v léčbě endometriomu a jejím vlivu na ovariální rezervu. Endometrióza postihuje 10–15 % žen ve fertilním věku. Přítomnost a terapie endometriomu ovlivňuje ovariální rezervu a díky tomu i koncepční možnosti pacientek. Management komplikují rovněž četné recidivy. Všechny standardně používané chirurgické metody vedou ke snížení ovariální rezervy. Současný klinický výzkum je zaměřen na vývoj metod, které by ovariální rezervu snižovaly co nejméně. Skleroterapie ethanolem je relativně novou alternativní metodou k dosud používaným chirurgickým metodám, převážně exstirpaci. Nejedná se zatím o standardní výkon. Tento článek si klade za cíl shrnout dosavadní poznatky o užití skleroterapie v léčbě endometriomu a její vliv na ovariální rezervu. Studie zahrnuté v tomto přehledovém článku vycházejí z databází PubMed a Scopus. Dle dosud publikovaných prací je skleroterapie relativně jednoduchou metodou, která umožňuje řešit endometriomy i bez operace a celkové anestezie, pokud je prováděna pod ultrazvukovou kontrolou. Má podobnou míru recidiv jako laparoskopická exstirpace a ve srovnání s ní při ní nedochází k většímu poklesu ovariální rezervy. Skleroterapii lze provádět transvaginálně, transabdominálně či laparoskopicky. Tato práce shrnuje dosavadní poznatky o vlivu skleroterapie na ovariální rezervu.

To summarize current knowledge on the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. Endometriosis affects 10–15% of women of reproductive age. The presence and treatment of endometriomas influence ovarian reserve, and therefore the conception possibilities of patients. The management is further complicated by frequent recurrences. All standard surgical methods lead to a reduction in ovarian reserve. Current clinical research is focused on developing methods that minimize the reduction of ovarian reserve. Ethanol sclerotherapy is a relatively new alternative to the currently used surgical methods, mainly extirpation. It is not yet a standard procedure. This article aims to summarize the current knowledge regarding the use of sclerotherapy in the treatment of endometriomas and its effect on ovarian reserve. The studies included in this review article are based on PubMed and Scopus databases. According to published works, sclerotherapy is a relatively simple method that allows treating endometriomas without surgery and general anaesthesia if performed under ultrasound guidance. It has a similar recurrence rate as laparoscopic extirpation and does not lead to a greater reduction in ovarian reserve compared to the latter. Sclerotherapy can be performed trans-vaginally, trans-abdominally, or laparoscopically. This paper summarizes the current knowledge on the impact of sclerotherapy on ovarian reserve.

• MeSH
• Anti-Mullerian Hormone analysis   MeSH
• Endometriosis * diagnosis   drug therapy   classification   MeSH
• Gynecologic Surgical Procedures methods   MeSH
• Laparoscopy methods   MeSH
• Humans MeSH
• Ovarian Reserve MeSH
• Sclerotherapy * classification   methods   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH

Monotherapy with a potent P2Y12 receptor antagonist after 1 month of dual antiplatelet therapy (DAPT) may reduce bleeding in the absence of increased ischaemic events compared to 12-month DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). PCI guidance with optical coherence tomography (OCT) may enhance stent expansion. COMPARE STEMI ONE is an international, multicentre, open-label, randomised controlled trial. In 1,656 ST-segment elevation myocardial infarction (STEMI) patients, prasugrel monotherapy after 1 month of DAPT, as compared to standard 12-month prasugrel-based DAPT, will be tested for non-inferiority for the primary composite endpoint of net adverse clinical events - defined as all-cause death, myocardial infarction, stroke, or Bleeding Academic Research Consortium Type 3 or 5 bleeding events - at 11 months after randomisation. Furthermore, an ancillary substudy will test the superiority of OCT-guided versus angiography-guided staged complete revascularisation in achieving a larger minimal stent area (MSA) in non-culprit lesions during staged procedures. COMPARE STEMI ONE is the first randomised controlled trial assessing an abbreviated 1-month DAPT regimen followed by prasugrel monotherapy in the context of STEMI. The trial will also study the value of OCT-guided PCI in terms of the MSA of non-culprit lesions and may elucidate potential synergies between intravascular imaging-guided PCI and abbreviated DAPT regimens. (ClinicalTrials.gov: NCT05491200).

• MeSH
• Purinergic P2Y Receptor Antagonists * therapeutic use   MeSH
• ST Elevation Myocardial Infarction * therapy   drug therapy   diagnostic imaging   surgery   MeSH
• Platelet Aggregation Inhibitors * therapeutic use   MeSH
• Coronary Angiography methods   MeSH
• Percutaneous Coronary Intervention * methods   MeSH
• Humans MeSH
• Tomography, Optical Coherence * methods   MeSH
• Prasugrel Hydrochloride * therapeutic use   MeSH
• Randomized Controlled Trials as Topic MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Clinical Trial Protocol MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

BACKGROUND: The European Medicines Agency has recommended a series of restrictions on the use of sodium valproate (valproate) following research linking its exposure in utero to adverse congenital and neurodevelopmental effects in offspring. Recent research has highlighted a potential increased risk of neurodevelopmental disorders in children born to males taking valproate prior to conception. Clinicians and patients require guidance regarding suitable alternatives. AIM: To provide an overview of suitable alternatives to valproate in the management of bipolar disorder. METHOD: A narrative review was conducted. Only medications with an established evidence base in managing different phases of bipolar disorder and endorsed within clinical practice guidelines were considered. Eligible guidelines included those (i) where recommendations were informed by a formal guideline development process and (ii) published in English within the last 15 years. REPROTOX® was chosen as the primary information source regarding reproductive safety of alternative medications. RESULTS: Of all second-generation antipsychotics, quetiapine should be considered a first-line alternative to valproate. Lithium has been associated with an increased risk of cardiac malformations, especially Ebstein anomaly, following in utero exposure. However, given its robust efficacy as an antimanic agent and the absolute risk of cardiac abnormalities being low, it's use can still be considered in individuals of child-bearing potential with appropriate monitoring. Carbamazepine treatment should be avoided due to concerns for teratogenicity. Although considered safe in pregnancy, lamotrigine is largely effective at preventing relapse of bipolar depression. Thus, lamotrigine offers limited clinical utility as an alternative to valproate. CONCLUSION: Specific recommendations are made regarding alternatives to valproate in managing bipolar disorder.

• MeSH
• Antimanic Agents * adverse effects   therapeutic use   MeSH
• Antipsychotic Agents * adverse effects   therapeutic use   MeSH
• Bipolar Disorder * drug therapy   MeSH
• Valproic Acid * adverse effects   therapeutic use   MeSH
• Humans MeSH
• Disease Management * MeSH
• Pregnancy MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Comparative Study MeSH
• Geographicals
• Europe MeSH

Considering the growing role of ultrasound-guided procedures in musculoskeletal medicine, training as regards these interventions is pivotal. While hands-on training on cadavers can be considered optimal, it has several drawbacks, e.g., high cost, poor availability, and technical challenges regarding preservation. Apart from cadavers, different approaches to practicing needle guidance are taught in ultrasound workshops whereby phantoms from meat (e.g., chicken breast), cheese or gelatin are used. Likewise, this article aims to provide a detailed description as to how different gelatin-based phantoms can be prepared. In line with the EURO-MUSCULUS/USPRM (European Musculoskeletal Ultrasound Study Group/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) protocols/background, the authors describe particular basic and advanced phantoms to be used for practicing different technical/manual skills pertaining to common ultrasound-guided procedures. The present manuscript can be considered a practical and ready-to-use "recipe book" for readers who are interested in the wide spectrum of interventional ultrasound.

• MeSH
• Phantoms, Imaging * MeSH
• Ultrasonography, Interventional * MeSH
• Clinical Competence MeSH
• Humans MeSH
• Musculoskeletal Diseases diagnostic imaging   rehabilitation   MeSH
• Physical and Rehabilitation Medicine * education   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure that has become a first-line treatment for esophageal achalasia and other esophageal spastic disorders. Structured training is essential to optimize the outcomes of this technique. The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in POEM. This Position Statement presents the results of a systematic review of the literature and a formal Delphi process, providing recommendations for an optimal training program in POEM that aims to produce endoscopists competent in this procedure. In a separate document (POEM curriculum Part II), we provide technical guidance on how to perform the POEM procedure based on the best available evidence. 1: POEM trainees should acquire a comprehensive theoretical knowledge of achalasia and other esophageal motility disorders that encompasses pathophysiology, diagnostic tool proficiency, clinical outcome assessment, potential adverse events, and periprocedural management. 2: Experience in advanced endoscopic procedures (endoscopic mucosal resection and/or endoscopic submucosal dissection [ESD]) is encouraged as a beneficial prerequisite for POEM training. 3: ESGE suggests that POEM trainees without ESD experience should perform an indicative minimum number of 20 cases on ex vivo or animal models before advancing to human POEM cases with an experienced trainer. 4: ESGE recommends that the trainee should observe an indicative minimum number of 20 live cases at expert centers before starting to perform POEM in humans. 5: The trainee should undertake an indicative minimum number of 10 cases under expert supervision for the initial human POEM procedures, ensuring that trainees can complete all POEM steps independently. 6: ESGE recommends avoiding complex POEM cases during the early training phase. 7: POEM competence should reflect the technical success rate, both the short- and long-term clinical success rates, and the rate of true adverse events. 8: A POEM center should maintain a prospective registry of all procedures performed, including patient work-up and outcomes, procedural techniques, and adverse events.

• MeSH
• Esophageal Achalasia * surgery   MeSH
• Delphi Technique MeSH
• Natural Orifice Endoscopic Surgery * education   MeSH
• Endoscopy, Gastrointestinal * education   MeSH
• Clinical Competence MeSH
• Curriculum * MeSH
• Humans MeSH
• Myotomy * education   methods   MeSH
• Pyloromyotomy * education   MeSH
• Societies, Medical MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Systematic Review MeSH
• Geographicals
• Europe MeSH

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) with the European Society of Gynaecological Oncology (ESGO) jointly developed clinically relevant and evidence-based statements on performing ultrasound-guided biopsies in gynecological oncology. The objective of this Consensus Statement is to assist clinicians, including gynecological sonographers, gynecological oncologists and radiologists, to achieve the best standards of practice in ultrasound-guided biopsy procedures. ISUOG/ESGO nominated a multidisciplinary international group of 16 experts who have demonstrated leadership in the use of ultrasound-guided biopsy in the clinical management of patients with gynecological cancer. In addition, two early-career gynecological fellows were nominated to participate from the European Network of Young Gynae Oncologists (ENYGO) within ESGO and from ISUOG. The group also included a patient representative from the European Network of Gynaecological Cancer Advocacy Groups. The document is divided into six sections: (1) general recommendations; (2) image-guided biopsy (imaging guidance, sampling methods); (3) indications and contraindications; (4) technique; (5) reporting; and (6) training and quality assurance. To ensure that the statements are evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on this review of the literature. During a conference call, the whole group discussed each preliminary statement, and a first round of voting was carried out. The group achieved consensus on all 46 preliminary statements without the need for revision. These ISUOG/ESGO statements on ultrasound-guided biopsy in gynecological oncology, together with a summary of the evidence supporting each statement, are presented herein. This Consensus Statement is supplemented by detailed narrated videoclips presenting different approaches and indications for ultrasound-guided biopsy, a patient leaflet, and an extended version which includes a detailed review of the evidence.

• MeSH
• Gynecology standards   MeSH
• Ultrasonography, Interventional * methods   standards   MeSH
• Consensus MeSH
• Medical Oncology standards   MeSH
• Humans MeSH
• Genital Neoplasms, Female * pathology   diagnostic imaging   MeSH
• Image-Guided Biopsy * methods   standards   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Review MeSH

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) with the European Society of Gynaecological Oncology (ESGO) jointly developed clinically relevant and evidence-based statements on performing ultrasound-guided biopsies in gynecological oncology. The objective of this Consensus Statement is to assist clinicians, including gynecological sonographers, gynecological oncologists and radiologists, to achieve the best standards of practice in ultrasound-guided biopsy procedures. ISUOG/ESGO nominated a multidisciplinary international group of 16 experts who have demonstrated leadership in the use of ultrasound-guided biopsy in the clinical management of patients with gynecological cancer. In addition, two early-career gynecological fellows were nominated to participate from the European Network of Young Gynae Oncologists (ENYGO) within ESGO and from ISUOG. The group also included a patient representative from the European Network of Gynaecological Cancer Advocacy Groups. The document is divided into six sections: (1) general recommendations; (2) image-guided biopsy (imaging guidance, sampling methods); (3) indications and contraindications; (4) technique; (5) reporting; and (6) training and quality assurance. To ensure that the statements are evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on this review of the literature. During a conference call, the whole group discussed each preliminary statement, and a first round of voting was carried out. The group achieved consensus on all 46 preliminary statements without the need for revision. These ISUOG/ESGO statements on ultrasound-guided biopsy in gynecological oncology, together with a summary of the evidence supporting each statement, are presented herein. This Consensus Statement is supplemented by detailed narrated videoclips presenting different approaches and indications for ultrasound-guided biopsy, a patient leaflet, and an extended version which includes a detailed review of the evidence. © 2025 The Authors. Published by John Wiley & Sons Ltd on behalf of The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and by Elsevier Inc. on behalf of the European Society of Gynaecological Oncology and the International Gynecologic Cancer Society.

• MeSH
• Gynecology * standards   MeSH
• Ultrasonography, Interventional * methods   standards   MeSH
• Consensus MeSH
• Medical Oncology standards   MeSH
• Humans MeSH
• Genital Neoplasms, Female * pathology   diagnostic imaging   MeSH
• Societies, Medical MeSH
• Image-Guided Biopsy * methods   standards   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Consensus Development Conference MeSH
• Research Support, Non-U.S. Gov't MeSH
• Practice Guideline MeSH

Structural, architectural, contractile, or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodelling has become a cornerstone diagnostic and prognostic marker. The structure and the function of the LA and left atrial appendage (LAA), which is an integral part of the LA, are key elements for a better understanding of multiple clinical conditions, most notably atrial fibrillation, cardioembolism, heart failure, and mitral valve diseases. Rational use of various imaging modalities is key to obtain the relevant clinical information. Accordingly, this clinical consensus document from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists and cardiac imagers for the best practice of imaging LA and LAA for the diagnosis, management, and prognostication of the patients.

• MeSH
• Echocardiography methods   MeSH
• Atrial Fibrillation diagnostic imaging   MeSH
• Cardiac Imaging Techniques MeSH
• Cardiology MeSH
• Consensus * MeSH
• Humans MeSH
• Multimodal Imaging * methods   MeSH
• Prognosis MeSH
• Atrial Appendage * diagnostic imaging   MeSH
• Societies, Medical * MeSH
• Heart Atria * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH